Abby Tighe thought she had landed her forever job. She joined the Centers for Disease Control and Prevention (CDC) in December 2023, managing a national youth substance abuse prevention program. The project focused on rural communities, and Tighe, whose family is from Appalachia, was proud to be using her public health training to support often-overlooked parts of the country. “The CDC was different than anywhere else I’ve worked,” says Tighe. “People didn’t care about their own ambitions as much as they cared about the larger mission. It was always my dream to work there.”
That dream ended a year ago, when Tighe received a form email on 14 February letting her know the Trump administration was firing her. Classified as a probationary worker, she was one of the first to lose her job in what quickly became a dramatic downsizing of the CDC workforce. To date, the current administration has either fired or is in the process of firing more than 4,000 CDC employees – a third of the agency.
While they battled to get their jobs back, Tighe and several other fired CDC employees banded together to create an improvised mutual aid network they called Fired But Fighting. But as the months dragged on, Fired But Fighting’s members watched as the administration, under the direction of Robert F Kennedy, the US health secretary, transformed the agency into something scarcely recognizable. Rather than focus on fighting for jobs that may no longer exist, they decided to grow into something new – to advocate for public health the way the CDC had always done it.
“We saw there was a need for an organization that stands in the gap,” says Aryn Backus, a former CDC health communication specialist who was fired on the same day as Tighe.
Last October, the group rebranded as an advocacy organization for evidence-based, nonpartisan public health and formed the National Public Health Coalition. The idea for a new name – less confrontational and more inclusive – had come in part from Jerome Adams, Donald Trump’s first-term surgeon general, now a sharp critic of the administration’s public health policies, who warned Tighe’s team during a web call last May that they would struggle to win over Republicans with the word “fighting” in their name.
The National Public Health Coalition’s members aren’t sure if they’ll ever get their jobs back. Instead, they’re applying the skills they once used at the CDC at this new organization. Data scientists run the CDC Data Project, which tracks budget and staffing cuts and their impact on everything from cancer research to controlling disease outbreaks. Communications experts dispatch to Capitol Hill, meeting with lawmakers and staffers to explain how projects they’ve championed, such as Alzheimer’s research or curbing domestic violence, are being eviscerated. Former press officers alert media to the downsizing’s real-world effects, like when Milwaukee health officials struggling to contain a lead contamination crisis found the CDC’s entire childhood lead prevention program had been eliminated (after a flurry of news stories, the team was hastily reinstated).
“It felt like a CDC response,” says Tighe. “Eventually we had this kind of ghost structure for how we do things.”
The National Public Health Coalition isn’t alone. Standing in the gap with them are other organizations, from professional medical associations to academic institutions, that together form a sort of “shadow CDC.”
As the Trump administration continues to dramatically reshape federal public health agencies, slashing research and issuing new health recommendations many see as blatant misinformation, these career health workers see this “shadow CDC” as a necessary temporary bulwark. But in the long term, they say, the goal will be to someday rebuild the CDC into a stronger, better version of itself – one that restores Americans’ faith in public health.
“We want to drive forward the rebuilding of trust, the reimagining of this system,” says Backus. “We think it’s going to be a decades-long thing, but we have to start building a foundation now.”
Fired workers band together
From the very first months, the Trump administration’s sweeping and erratic approach to CDC layoffs had one upside for the new organization: terminated workers had a wide range of technical skills. “You’re firing all these people with really great expertise,” says Tighe, “And we weren’t going to go down quietly.”
Marie had been a CDC health scientist for over a decade when she was fired as part of the 1 April “Reduction in Force” that eliminated 2,400 CDC workers, 800 of which were later reinstated. (Marie requested to only use her middle name, per the advice of the lawyers representing her and other fired workers in an active lawsuit.)
Overnight, Marie, who had been monitoring health worker outreach programs in sub-Saharan Africa as part of the Division of HIV and Tuberculosis, found herself on administrative leave and barred from work. She joined Signal group chats where bewildered colleagues were sorting through the chaos unfolding at the agency. A few weeks after her firing, she saw a post there announcing that a newly formed group of fired CDC workers was looking for volunteers with data expertise.
“I do a lot of data analytics and visualization, and it sounded like they could use some of those skills,” she says.
The call had come from Fired But Fighting, which Tighe, Backus and several axed probationary workers had started as a newsletter back in early March. Initially, they too had turned to group chats, which ballooned as more people lost their jobs. “We didn’t know what was going on with our insurance or retirement,” Tighe says. “There were just so many things up in the air because this was done so haphazardly.”
Tighe and Backus had the idea to launch a newsletter, which contained useful information like lawsuit updates and tips from the CDC union. They turned Fired But Fighting into a website, which went live a day before the reduction-in-force blitz that cost Marie her job. Word spread about the fledgling project, and soon dozens of fired workers were reaching out to organize mutual aid, track lawsuits and alert the media to the cuts besieging the CDC. “We looked at each other and said: ‘I guess this is an actual organization now’,” says Backus.
After Marie responded on Signal, a Fired But Fighting admin connected her with a small group of data scientists, including one who’d lost her USAID job after the agency was eliminated (the move is being challenged in federal court). Their task: take the billions of dollars of budget cuts and thousands of staff terminations, and turn that mountain of data into something the public could understand.
“I had never worked with budget data, but sometimes at the CDC when you’re in the field, you just have to become an expert as quickly as you can,” says Marie. She and her new colleagues pooled expertise to stand up the CDC Data Project, where the quantitative impact of decimated public health projects is translated into understandable graphs, maps and spreadsheets.
As the co-leader of the National Public Health Coalitions’s data work group, Marie oversees 40 volunteers, who review federal budget data and update the CDC Data Project dashboard regularly. Projected budget cuts will continue to carve out the agency. “This administration keeps us on our toes,” she says dryly. But she sees the data dashboard as critical to the National Public Health Coalition’s advocacy work, sounding the alarm about critical cuts to public health.
“The administration can say, for example, that they’re emphasizing chronic disease as a major priority,” Marie says, “But you can see in the president’s budget proposal that they’re cutting all the chronic disease programs. So the more we can share what’s really happening with the public, with Congress, with journalists, the more we can counter the misinformation and push back against a lot of what’s happening.”
‘This administration keeps us on our toes’
Today, the National Public Health Coalition has about 100 regular volunteers, plus another 50 who lend intermittent support. The coalition is in the process of filing for non-profit status, but covers its operational costs with small-dollar donations and merchandise sales.
In addition to the data work group, the coalition runs an advocacy arm, which updates members of Congress and their staffers about the impacts of the Trump administration’s dramatic public health overhaul. For instance, when funding was cut for research on sickle cell anemia – a debilitating health condition that disproportionately affects Black communities – coalition members met with health staffers for Tim Scott, a South Carolina senator, who has long advocated for those with the disease. Scott later brought up the issue in committee hearings.
A legal team tracks the various lawsuits and merits appeals that will determine the status of workers’ firings, and a social media team posts savvy content to two accounts. One, still called Fired But Fighting, is “a little spicier”, jokes Tighe – that group lives on as the coalition’s “resistance arm”, where terminated employees connect and organize protests.
But with a long-term goal beyond regaining lost jobs, the National Public Health Coalition has shifted its mission: communicate the life-changing impact public health has on people’s lives, in ways that will actually reach them.
“We haven’t done a good job of this in public health,” says Tighe, noting that the Covid-19 pandemic furthered perceptions of the CDC as out of touch with local communities. “I think Covid is the spark that lit the fire, but I would argue we’ve been stacking the firewood.”
These health communications experts are full of ideas, from less reliance on technical language to better engagement on social media. The coalition is also working to get more public health professionals in health staffer roles in Washington, or even encouraging them to run for office themselves. “It’s not that we have the science wrong, it’s that sometimes people have a hard time relating to it,” says Marie. “We have to revamp the way we communicate about our work.”
Adams, Trump’s first surgeon general, believes their position outside the federal government will be helpful in reaching a public skeptical of career civil servants.
“This gives them an opportunity to say: ‘I’m not doing this because I’m being told to by Biden or Trump – I’m doing this because I believe it’s the right thing to do,’” says Adams, who is now professor and executive director of the Center for Community Health Enhancement and Learning at Purdue University.
How the ‘shadow CDC’ is reframing public health
As the federal government pulls back on its commitments to public health – and in some cases actively sows distrust in the field, as with new CDC webpages falsely suggesting a link between childhood vaccines and autism – other organizations are also scrambling to fill the void.
“A number of non-profits, the medical care community, researchers and scientists – lots of different people are stepping up,” says Susan Polan, associate executive director of public affairs at the American Public Health Association, which has collaborated with the Coalition on public outreach. “People are trying to figure out how to continue offering services, how to make do with less.”
Projects like Yale University’s PopHive and the Data Rescue Project are working to preserve federal data, ensuring statistics aren’t corrupted by meddling and keeping critical longitudinal studies intact. State public health agencies are banding together to speak in one voice about vaccine safety and respond cohesively to health emergencies. Professional organizations like the American Academy of Pediatrics are bolstering their own webpages to provide Americans with clear, science-backed information.
This is, in effect, the “shadow CDC”: non-government organizations, individual researchers and lower-level governments, all standing in for the federal agencies that, until recently, led the way.
For the time being, these substitutes will have to do, says Adams. “We’re in a moment where authority for health policy and messaging is being pushed down to the state and local level,” he says. “It breaks my heart to think that people’s health is going to increasingly be tied to where they live. But for now, it’s going to be imperative that we have groups like the National Public Health Coalition that people feel they can trust.”
Nevertheless, it’s unlikely a “shadow CDC” can replace what’s being lost.
“An organization is not a government,” Tighe says. “We can’t go to the World Health Organization and represent the United States; we don’t have the money to fund a state or local health department.”
Instead, the members of the National Public Health Coalition hope their organization can be a part of rebuilding a stronger, non-partisan federal public health system – whether it’s called the CDC or something else entirely –that is widely trusted by the American people.
“There is real recognition that the phoenix that arises from these ashes can be better,” says Polan. “More engaged with communities, more able to work across sectors and not be so siloed.”
As for their old CDC jobs, the ones they started this fight for; many in the National Public Health Coalition aren’t sure if they’d take them back, even if their appeals are successful.
“Not in the current circumstances,” says Backus. “Maybe in a few years, after we’ve worked to build something stronger – something better for everyone.”